Ask Billing Questions Here!

[BillingSpecialist]

Is it necessary to have the patient's full past medical history, current medications and allergies listed in the patient care report when doing an interfacility transfer than has a PCS?

For billing purposes......no not a full medical history. The medical history is important if it pertains to the necessity of the trip. For example, if the patient has a hx of acid refulx, that's not really gonna matter in proving the trip was needed. Current meds aren't really important to a biller, allergies could be. The more information you can provide about everything will make things alot smoother. And just because you have a PCS isn't enough any more. Anything that dr puts on that PCS needs to be documented on your trip report as well.

 

[Brandon O]

... why allergies?

Are broad medical "reasons" like dementia acceptable, or does there need to be clarification of why that diagnosis prevents the person from going by other means?

Any suggestions when nurses shrug and say, "What should I put? We send everybody by ambulance by policy."

 

[BillingSpecialist]

... why allergies?

Are broad medical "reasons" like dementia acceptable, or does there need to be clarification of why that diagnosis prevents the person from going by other means?

Any suggestions when nurses shrug and say, "What should I put? We send everybody by ambulance by policy."

Allergies could be used to code diagnosis, it's not common that they could be useful.

It really needs to be clarification of why that diagnosis prevent the person from going by other means. The more specific the better!!

You need to tell the nurse "If you can't think of anything to put on there that determines the patient needs to go by ambulance, then load the patient up in your car & take them to the hospital." LOL!!! I'm not sure I have a good answer for this one. This has to be something they can put on there, some kind of medical history, weakness....something.

 

[BeachMedic]

Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.

 

[BillingSpecialist]

Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.

Yes, I bill for several counties that are billing for the AMAs.

 

[Sublime]

It really needs to be clarification of why that diagnosis prevent the person from going by other means. The more specific the better!!

I feel like my transfer charts are pretty solid. The first 4 lines are always the same thing. Why the patient came to the ER. What the diagnosis was. Where they are being transferred from and to what facility for what reason. And why they require ambulance.

At least for ALS transfers the reason is is usually obvious, but sometimes I am unsure what to put. BLS transfers become more tricky on what to put because a lot of times they are literally just getting a ride in the back with some vitals taken and that's it.

Many times I have charted "Pt. requires ambulance transfer due to need for pain management en route secondary to right tibia fracture (or whatever it is that causes pain)." Does pain management count as a legitimate reason for ambulance transfer?

 

[BillingSpecialist]

The ALS calls are usually the easiest, not hard to prove.

Pain management would work, list pain scale (ex: pain 9/10), what kind of pain management (meds), tib/fib fx could also cause unsteady gait or weakness. The BLS calls are harder to determine before hand, almost every one will be handled differently or have different circumstances that apply.

 

[Brandon O]

What measures will you take to receive payment from patients if their insurance denies the claim (or they are uninsured)? To what extent can there be discounts or deals made?

 

[Christopher]

Do you bill for AMAs? I know some counties are starting too. I think that is ridiculous.

Why is billing for an AMA Treat and Release ridiculous?

 

[BeachMedic]

Why is billing for an AMA Treat and Release ridiculous?

Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.

So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with. Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.

Also, some of the local Medics are wondering whether or not to have the Fire Department handle all AMAs/refusals then since it is still not in their policy to bill. The fire guys are going to hate doing all the paperwork though.

I'll be the first to admit that this is just how I feel personally about the issue and that I'm not used to this new idea of non-transports receiving bills from us since it had not been done in my area previously.

 

[Brandon O]

Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill.

Presumably these would generally be outright refusals of care, not "treat-and-release" situations where medication or other care was received (with consent), yet transport was refused.

 

[usalsfyre]

Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.

Probably will see more and more of this. Reimbursement is tightening all around.

So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with.

I can get behind this...

Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.

...but not this? Why would we not, outside of a misplaced sense of nobility? You think a physician doesn't bill for his time and expertise on an unsuccessful resus? The hospital writes off the supplies? A typical resus will use use a couple of hundred dollars in supplies and tie up an hr of truck time (say $100-200/hr operating cost). Why would you not seek reimbursement for that?

Also, some of the local Medics are wondering whether or not to have the Fire Department handle all AMAs/refusals then since it is still not in their policy to bill. The fire guys are going to hate doing all the paperwork though.

Sure, you can deliberately drive down your service's revenue stream...don't complain about money or equipment though.

I'll be the first to admit that this is just how I feel personally about the issue and that I'm not used to this new idea of non-transports receiving bills from us since it had not been done in my area previously.

It's a short-sighted view that many in EMS share unfortunately. At the moment medicine is a business in the US. EMS providers need to start realizing this.

 

[Aidey]

Lets keep it to billing questions guys.


If we are transporting a patient who is normally wheelchair bound, but uses a highly specialized wheelchair and is unable to use a normal wheelchair, is explaining that enough to meet necessity requirements?

 

[BillingSpecialist]

What measures will you take to receive payment from patients if their insurance denies the claim (or they are uninsured)? To what extent can there be discounts or deals made?

When I bill for patients who don't have insurance, I will first run them through the state medicaid system to see if they have coverage. Then I will send a form to the patient along with their statement for them to fill out & return to me. If I get no response from that, I will contact the patient. If I can't get a response from the patient, I will call the hospitals or nursing homes they were taken too & see what insurance they have, if any, for the patient. I go to all measures possible to find their insurance. Now if they are MVA's I handle those a little differently, those you have to stay on top of so you don't lose your money.

You have to make a "faithful attempt" to collect from the patient before you do anything else. There is no standard to follow for a faithful attempt, but you have to be consistent. I personally feel like a faithful attempt would be 3 statements.

 

[BillingSpecialist]

Historically, in the areas I've worked we had never billed for AMAs. Now it is something that I heard has started within the last month.

So maybe i'm just not used to it. Multiple situations have come up where a Pt did not activate the 911 system and due to a technicality that Pt is now receiving a bill. Something I do not agree with. Also, I do not agree with a Pt's family receiving a bill if we work a cardiac arrest and leave their loved one on scene.

Also, some of the local Medics are wondering whether or not to have the Fire Department handle all AMAs/refusals then since it is still not in their policy to bill. The fire guys are going to hate doing all the paperwork though.

I'll be the first to admit that this is just how I feel personally about the issue and that I'm not used to this new idea of non-transports receiving bills from us since it had not been done in my area previously.

Some of the companies that I bill for will only bill for a non-transport if they've done some kind of work on the patient. A lot of the time, these non-transport billings are established for the people who take advantage of the ambulance, like the lady who calls all the time for help up from her chair, or the guy who calls just to get free meds....you all have those kinds of people.

 

[Brandon O]

You have to make a "faithful attempt" to collect from the patient before you do anything else. There is no standard to follow for a faithful attempt, but you have to be consistent.

What does "anything else" amount to? Going to collections? Lawsuits?

If there is actually no insurance, is the straight cash rate discounted at all?

 

[BillingSpecialist]

You're absolutely right on the cardiac arrest patients. I know it stinks for the loved ones, but it's a billable service. It's billable to Medicare (just the loading, no mileage) & if there's no Medicare & the patient has an estate, you can have it applied to the estate.

 

[BillingSpecialist]

"Anything else" refers to collections, lawsuits, write offs of any kind.

Nothing should be discounted until a "faithful attempt" is made. There should be some kind of policy in place for handling those accounts that you get no response on. It should also be standard....for all patients.

 

[BillingSpecialist]

Lets keep it to billing questions guys.


If we are transporting a patient who is normally wheelchair bound, but uses a highly specialized wheelchair and is unable to use a normal wheelchair, is explaining that enough to meet necessity requirements?

Those are tricky transports. If you have enough detail in your explanation & can get a doctor to sign off on a medical necessity (PCS), you should be okay.

 

[Scott33]

"Anything else" refers to collections, lawsuits, write offs of any kind.

Nothing should be discounted until a "faithful attempt" is made. There should be some kind of policy in place for handling those accounts that you get no response on. It should also be standard....for all patients.

How do you collect from foreign nationals who are visiting the US, but end up using EMS services? Particularly those who neglect to take out travel insurance (not mandatory for travel to the US).